Provider Demographics
NPI:1922311257
Name:OBI, JACINTHA NWAODAKU
Entity Type:Individual
Prefix:
First Name:JACINTHA
Middle Name:NWAODAKU
Last Name:OBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 MONTICELLO AVE
Mailing Address - Street 2:BRONX
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2111
Mailing Address - Country:US
Mailing Address - Phone:718-231-9695
Mailing Address - Fax:
Practice Address - Street 1:4215 MONTICELLO AVE
Practice Address - Street 2:BRONX NEW YORK
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2111
Practice Address - Country:US
Practice Address - Phone:718-231-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607009-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator